Direct-to-Consumer Genetic Testing Summary of a Workshop (2011) / Chapter Skim
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Impact on Health Care and Public Health
Impact on Health Care and Public Health
Pages 23-30
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From page 23... ...
ECONOMICS1 DTC genetic testing might lower overall health care costs by: • Encouraging behavior changes and other prevention strategies: This is more likely for highly penetrant genes such as BRCA1 and BRCA2, whereas low-risk genes from a GWAS may have less impact; 2 1 Unless otherwise noted, the section "Economics" reflects the remarks of Kathryn Phillips, Professor of Health Economics and Health Services Research, University of California, San Francisco. 2 This sentence taken from the remarks of Patricia Ganz, Professor of Health Services, School of Public Health and Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
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From page 24... ...
In addition, the test must be reliable, sensitive and specific; it must have strong posi tive and negative predictive values and be actionable. PHySICIAN AWARENESS AND EDUCATION DTC genetic testing companies generally advise clients to discuss test results with their health care providers -- the majority of whom are not yet equipped to interpret the results and advise their patients.
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From page 25... ...
and numerous journal articles 4 From the remarks of Patricia Ganz, Professor of Health Services, School of Public Health and Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles 5 Kolor K, Liu T, St Pierre J, Khoury M., Health care provider and consumer awareness, per ceptions, and use of direct-to-consumer personal genomic tests, United States, 2008, Genetics in Medicine.
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From page 26... ...
wrote in the Journal of the American Medical Association that "the primary care workforce, which will be required to be on the frontlines of the integration of genomics into the regular practice of medicine, feels woefully unprepared to do so."9 • In an article in Nature Reiews Genetics 10 on challenges to genetics education for physicians and other health professionals, Guttmacher et al listed a crowded curriculum, misconceptions about genetics, lack of knowledgeable faculty, a disconnect between basic sciences and clinical experiences during training, inadequate representation of genetics on certifying exams, and failure to integrate genetics across the curriculum. • In Genetics in Medicine, Suther and Goodson11 listed a variety of challenges to integrating genetics into primary care: a dearth of genetics professionals, lack of knowledge about genetics among primary-care providers, lack of confidence, lack of referral guidelines, difficulty interpreting genetic tests, and difficulty explaining genetic risks to patients.
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From page 27... ...
Only two medical schools -- in the University of Vermont and Johns Hopkins University -- currently incorporate genetics training into all four years of medical school. Even if this became the norm, however, it will be decades before medical schools produce a critical mass of physicians with the knowledge and confidence to be as comfortable with medical genetics as they will be with the more traditional aspects of health care.
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From page 28... ...
providers about genetics. To date, however, the center has dealt primarily with single-gene disorders; it has recently begun to address the enormous need to educate the NHS work force on the genetics of common diseases.17 In the long run, many participants agreed that it appears that the health care system will need more primary care physicians knowledgeable about genomics and more genetic counselors.
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From page 29... ...
As DTC testing becomes more widespread and the industry evolves, reimburse ment may become an issue in this context as well.22 QUESTIONS RAISED FOR FURTHER DISCUSSION • How can health care systems, in the United States and elsewhere, ensure that the enormous potential of genetic testing generally -- and DTC testing in particular -- is harnessed and directed to maximize its benefits for human health? • What are the most effective ways to incorporate genetics into 20 From the remarks of Patricia Ganz, Professor of Health Services, School of Public Health and Professor of Medicine, David Geffen School of Medicine, University of California, Los Angeles.
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• In light of the general public's lack of information in the areas of health literacy and genetics and in particular of the role, risks, and benefits of genetic testing in health care, what are the most effective ways to educate the public in these areas? Would multiple education strategies best serve the public interest?
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